Drug and Alcohol Abuse in the Military Research Paper

Substance Abuse of Military Personnel and Veterans and Appropriate Sources of Treatment

Substance abuse is an increasingly serious problem amongst military personnel and veterans. Not all treatment methods are created equal, however. This research will seek to specifically explore and evaluate one of the most commonly recommended methods to address Substance Abuse in the form of 7 dimensions stress therapy (7 DST).

dimensions stress therapy (7 DST) and combined psychotherapy will be shown to be both more effective for the patient and also more cost effective for the healthcare system because of its targeted and goal-oriented approach.

Is 7 DST and combined psychotherapy more effective in addressing substance abuse in veterans and service personnel?

Literature review

To understand how to treat substance abuse one must first understand its cause. However, the cause of substance abuse, or why certain individuals become addicted to drugs while others do not, is much-debated amongst researchers. Not everyone who tries alcohol or even hard drugs becomes addicted. However, certain external factors seem to have a clear effect upon the likelihood of engaging in addictive behaviors. High levels of stress, including military deployment increases one's likelihood of both depression and substance abuse in all branches of the military, according to Shen, Arkes, & Williams (2012). In their study of all active duty personnel serving between 2001 and 2006, active duty members of the Army, Navy, Air Force, and Marines all had a higher risk of substance dependence. In the case of the Army, increased length of deployment further exacerbated the risk.

Case management has become a more and more common approach to deal with the challenges of substance abuse, particularly in the era of managed care according to Yeager (1999): "Case management was reported to be utilized to coordinate services, and to monitor, arrange, and evaluate a variety of services established to meet the specific needs of each client. Areas of case management in which today's effective substance dependence counselors should demonstrate proficiency were reported to be: screening, comprehensive assessment, care planning, service arrangement, monitoring, and reassessment" (p.150). Case management ensures coordination of critical services to make therapy more targeted and efficient. However, case management must be effectively coordinated to treat the client's unique and specific needs and by definition deploys a large treatment team to address patients need. This is not always feasible for patients and providers.

Other methods of creating cost-effective treatment include the use of online therapy. More and more, critical services are shifting online, spanning everything from shopping to education and now counseling is no different. Although it might not seem possible to provide something as critical as substance abuse counseling to veterans online, a study by Voorhees, Gollan, & Fogel (2012) found the use of online counseling to be effective for veterans experiencing depression and PTSD, both of which are positively correlated with substance abuse. The study specifically focused on a goal-directed therapy approach which is considered one of the most successful approaches to take with individuals struggling with this particular issue. Combined with online peer support, mental health symptoms improved considerably over the 12-week longitudinal study. The study did not have a control group but was promising given the potential benefits of such a cost-effective solution. "Internet-based models could offer both indicated prevention and early treatment outside the formal system of care or within either primary care or mental health clinic intake programs" (Voorhees, Gollan, & Fogel, 2012, p.1187).

The therapeutic design allowed participants to set specific, meaningful goals for treatment in a concrete manner and supported the development of positive coping mechanisms with rational thoughts. Peer support reinforced the therapeutic goals and also the willingness of the participants to seek help outside the program, which is often a particular challenge with veterans who feel it is 'weak' to seek help. "Conditions perceived to be controllable by the affected individual, notably psychological problems, are more likely to elicit anger and punishing reactions rather than pity or assistance. Studies with both military and civilian populations have illustrated that those with higher levels of mental health symptoms (i.e., those with more symptoms or more severe symptomatology) report the greatest concerns regarding stigma" and are paradoxically often the least willing to seek help (Olmsted et al., 2011, p.53).

Although this particular study did not focus upon substance abuse goal-oriented therapies like 7-DST have also been used to great effect with substance abusers given the goal-oriented nature of the therapy. Setting goals for reducing drug use and replacing negative coping mechanisms with positive ones is part of the structure of the therapy. Also, the focus is on changing thoughts to change behaviors and the idea that adopting new life habits is essential to make a change. Substance abusers often have an ambivalent attitude about letting go of their addiction and 7-DST helps to better address the reasons for this. The structured nature of the therapy allows for the use of such unconventional venues as online therapy to administer treatment.

Once again, this study was not specifically conducted upon service personnel but given that the majority of military personnel facing combat are young adults, this study supports the notion that it is highly beneficial to use goal-directed methods to address substance abuse issues in young people. This also recommends the use of 7-Dimensional Therapy, in which patients talk with counselors, take specific surveys to address their needs (including the 7 dimensional-adverse childhood experiences survey (ACES), 7 dimension-psychosocial Stressors Inventory (7D-PSI), and 7 Dimensional-Therapeutic Activity Survey (7D-TAS)) and then set goals with the therapists (Slobodzien 2005). These goals are then matched to specific therapeutic approaches spanning from Eye Movement Desensitization and Reprocessing (EDMR) to more standard Cognitive Behavioral Therapy (CBT) (Slobodzien 2005).

Goal-oriented therapies have been particularly effective in addressing not only substance abuse but also eating disorders, OCD, phobias, and a wide variety of conditions associated with negative coping mechanisms psychiatric patients are often unwilling to abandon. The ambivalence many addicts may have to abandoning their addiction has been a long-documented part of the problems of substance abuse. However, this problem may be exacerbated by the fact that the use of drugs to treat a variety of problems has become quite accepted in our society, to the point that borderline abuse of prescription medications is pervasive. According to Manchikanti, Fellows, Ailinani, & Pampati (2012), "Americans, constituting only 4.6% of the world's population, have been consuming 80% of the global opioid supply, and 99% of the global hydrocodone supply, as well as two-thirds of the world's illegal drugs" (p. 401).

Although these statistics do not specifically pertain to combat veterans, it should be noted that given many veterans may use opioids for legitimate reasons (i.e., chronic pain) they are more likely to become dependent upon the drug for psychological, non-palliative reasons because of these drug's intense addictive properties. Opioid-based painkillers have a similar psychopharmacological makeup to heroin, one of the most notorious addictive 'street' drugs. These drugs can be acquired illegally or even legally from overzealous physicians or patients that engage in dishonest tactics such as doctor shopping to get such drugs (Manchikanti, Fellows, Ailinani, & Pampati, 2012, p.420). Once again, these problems are not confined to veterans but individuals that have taken prescription painkillers in the past may be at higher risk for addiction. That is why a 2015 study by the Institute of Medicine in the peer-reviewed Journal of Military Medicine cautioned healthcare providers that "additional structural changes" are needed in treatment and warned of the need to "involve prescribers, who should routinely check local prescription drug monitoring programs before dispensing medications with high abuse potential. Health care professionals also should be trained to recognize worrisome patterns of prescription drug use and medication-seeking behaviors and should be given clear guidelines for referral to specialty providers" (p.243).

Identifying service personnel at high potential risk for substance abuse even before they enter combat would be beneficial. A recent study of substance abusers overall "found that most of the users had initiated substance abuse during 15-18 years of age, with peer influence, curiosity and sense of growing being the chief reasons for initiation. A majority of the users were aware of the potential negative effects of substances yet they chose to start using these substances" (Sharma, 2015, p.1.). Providing a confidential venue to allow individuals to identify themselves and receive counseling (again, taking away the stigma from the behavior) would be extremely helpful; again, many service personnel may still be resistant to seeking help, particularly if they are concerned that it may reflect poorly upon their future career. The military currently conducts drug urinalysis of troops and positive test results are well below that of the average civilian population; however, this does not address the problem of addiction in veterans or potential addiction to alcohol prescription medications (Platteborze, Kippenberger, & Martin 2013). The fact that there is a high rate of substance abuse amongst returning soldiers and veterans also suggests it is possible that the current testing program leaves many abusers or vulnerable individuals prone to future…
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